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Concepts By Design Job Application

Concepts by Design is an equal opportunity employer. This application will not be used for limiting or excluding any applicant from consideration for employment on a basis prohibited by local, state, or federal law. Should an applicant need reasonable accommodation in the application process, he or she should contact a company representative.

Please fill out all sections below:

Applicant Information

Name

Address

City, State, Zip

Telephone

Email Address

Date

2. EMPLOYMENT POSITION

How did you hear about this position?

What days are you available to work?

What hours or shift are you available to work?

If needed, are you able to work overtime

Yes No

On what date can you start working if you are hired?

Do you have reliable transportation to and from work?

Desired salary or hourly rate?

3. PERSONAL INFORMATION: Do you have any friends, relatives, or acquaintances working for Concepts by Design? Yes No If yes, state name and relationship:

Are you a U.S. Citizen or approved to work in the United States?

What document can you provide as proof of citizen status or legal status?

Will you consent to a mandatory controlled substance test?

Do you have any condition(s) which would require job accommodations?

If yes, please describe accommodations required below.

(Note: Concepts by Design complies with the ADA and considers reasonable accommodation measures that may be necessary for eligible applicants/employees to perform essential functions. It is possible that a hire may be tested on skill/agility and may be subject to a medical examination conducted by a medical professional.)

Have you ever been convicted of a criminal offense (felony or misdemeanor)?

If yes, please state the nature of the crime(s), when and where they were committed, and disposition of the case:

(Note: No applicant will be denied employment solely on the grounds of conviction of a criminal offense. The date of the offense, the nature of the offense, including any significant details that affect the description of the event, and the surrounding circumstances and the relevance of the offense to the position(s) applied for may, however, be considered.)

4. JOB SKILL/QUALIFICATIONS: Please list below the skills and qualifications you possess for the position for which you are applying:

5. MILITARY: Are you a member of the armed services?

What branch of the military did you enlist?

What was your military rank when discharged?

How many years did you serve in the military?

What military skills do you possess that would be an asset for this position?

6. EDUCATION AND TRAINING: High School: Name

High School: City

High School: Date Graduated

College or University: Name

College or University: City

College or University: Date Graduated

College or University: Degree Earned

Vocational School, Specialized Training: School

Vocational School, Specialized Training: City

Vocational School, Specialized Training: Date Graduated

PREVIOUS EMPLOYMENT: Previous Employer: Name

1. Previous Employer: Job Title

1. Previous Employer: Supervisor Name

1. Previous Employer: Employer Address

1. Previous Employer: City, State, Zip

1. Previous Employer: Telephone Number

1. Previous Employer: Dates Employed

1. Previous Employer: Reason For Leaving

2. Previous Employer: Name

2. Previous Employer: Job Title

2. Previous Employer: Supervisor Name

2. Previous Employer: Employer Address

2. Previous Employer: City, State, Zip

2. Previous Employer: Telephone Number

2. Previous Employer: Dates Employed

2. Previous Employer: Reason For Leaving

3. Previous Employer: Name

3. Previous Employer: Job Title

3. Previous Employer: Supervisor Name

3. Previous Employer: Employer Address

3. Previous Employer: City, State, Zip

3. Previous Employer: Telephone Number

3. Previous Employer: Dates Employed

3. Previous Employer: Reason For Leaving

8. ADDITIONAL INFORMATION: Are you willing to travel if needed?

Yes No

What shifts are you willing to work (1st and/or 2nd)?

First Second

AT-WILL EMPLOYMENT: The relationship between you and the Concepts by Design is referred to as “employment at will”. This means that your employment can be terminated at any time for any reason, with or without cause, with or without notice, by Concepts by Design. No representative of Concepts by Design has authority to enter into any agreement contrary to the forgoing “employment at will” relationship. You understand that your employment is “at will,” and that you acknowledge that no oral or written statements or representations regarding your employment can alter your “at will employment” status, except for a written statement signed by you and either one or both owners of Concepts by Design.

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